The Path to Midwifery

If you're interested in becoming a midwife, there's a lot of information that you should be aware of. To begin with, there are four different types of midwives: lay midwives (not certified, with informal training), certified professional midwives (non-nurse midwives who have passed a national exam), certified midwives (non-nurse midwives with a bachelor's degree, midwifery education and who have passed a national exam) and certified nurse-midwives (registered nurses who have passed a national exam).

We'll be focusing on the latter. So, what does it take to become a certified nurse-midwife (CNM)?

Getting certified

A certified nurse-midwife is a registered nurse who has finished coursework that carries the stamp of approval by the Accreditation Commission for Midwifery Education (ACME). Advanced educational credentials in both midwifery and nursing are prerequisites for a certified nurse-midwife.

It doesn't stop there. Also required is the completion of the certification programs mandated by the American Midwifery Certification Board. Specific requirements a midwife must abide by to become certified include the training that qualifies as an associate post-secondary degree, laid down by each state.

RNs must pass a national board exam administered by the American Midwifery Certification Board before kicking off their career as a certified nurse-midwife. Additionally, once every five years, licensed midwives are required to complete and pass a recertification exam by the AMCB.

Fledgling midwives apparently have been relatively undaunted by the level of preparation. According to the American Midwifery Certification Board, as of February 2019, there were 12,218 CNMs and 102 CMs. Obviously, the majority of midwives in the United States are CNMs.

There are various routes to midwifery education and training in the U.S. Most culminate in midwifery certification and position a candidate for licensing in his or her state or municipality. Several channels are available to those on a path to becoming a certified and licensed midwife, including leveraging nurse-midwifery or direct-entry midwifery educational programs.

Benefits and drawbacks of becoming a midwife

Not to be overlooked, naturally, is salary. The average annual salary for the 90th percentile or top 10 percent of the highest-paid nurse midwives is $179,770, and the median annual salary is $111,130. For the bottom 10 percent, the average annual salary is $67,710.

Financial benefits aside, there's also the opportunity to meet and assist new mothers, witness the miracle of birth and help mothers through difficult deliveries. On the flip side, potential midwives may be discouraged by irregular hours, fatigue, lack of medical respect and bad birth outcomes.

The function of midwives in the healthcare system

Where there are more midwife-friendly laws and regulations, states tend to see decreased rates of premature births, cesarean deliveries and newborn fatalities—at least according to research conducted by the University of British Columbia's Division of Midwifery.

The study discovered a strong connection between the role of midwives in the healthcare system, what researchers call "midwifery integration," and birth outcomes. The report card results were generally better in states such as Washington and Oregon with high midwifery integration, while there were poorer outcomes in states, primarily in the Midwest and South, with the least integration. Research on this topic is scarce, but these numbers are encouraging as to the benefits of midwives.

Midwives participate in approximately 10 percent of U.S. births, severely trailing other industrialized countries, where midwives participate in at least half of all deliveries. Each state boasts its own laws and regulations on the credentialing of midwives, their ability to provide services at a client's home or at birth centers, authority to prescribe medication as well as hospital access.

If you are interested in joining this important field, reach out to midwives to learn from their experience, research further about the industry and talk to other healthcare professionals for advice.